Ketamine is commonly used for procedural sedation and analgesia. It is widely used for trauma
cases in the emergency department and is considered a superior agent in the outpatient
setting due to its lack of respiratory and cardiovascular depression. In chronic opioid
users, ketamine decreases acute pain and reduces postoperative opioid consumption. Few
studies have examined the use of ketamine for surgical abortions. Previous studies found
significant rates of emergence phenomena; however, this can be prevented if a benzodiazepine
is given at the same time. Ketamine deserves further study to determine whether it is an
acceptable alternative to a standard opioid-based regimen for surgical abortion. Our primary
objective is to compare patient satisfaction after surgical abortion among patients receiving
IV ketamine versus IV fentanyl for procedural sedation. Our secondary objectives include
postoperative pain, additional pain medication used, and postoperative opioid use after the
procedure. Our hypothesis is that ketamine will provide similar patient satisfaction and
reduce postoperative opioid use. This will be a randomized controlled noninferiority clinical
trial of 84 women receiving either IV ketamine with IV midazolam or IV fentanyl with IV
midazolam for outpatient one day surgical abortions up to 13, 6/7 weeks gestation. Both
groups will receive a standardized paracervical block and additional pain medication as
needed. Our study has the potential to introduce IV ketamine as a satisfactory medication for
outpatient surgical abortions. Ketamine may decrease the need for IV fentanyl, reduce
postoperative opioid use, and may prove to be a superior analgesic for chronic opioid users.